Healthcare technician delivered screening of adults with diabetes to improve primary care provider recognition of depression.

Dear Editor,

This is in reference to the article entitled “Healthcare technician delivered screening of adults with diabetes to improve primary care provider recognition of depression” published in your journal.[1] In spite of my reservation with the methodology adopted for conducting this study, I am happy to see a publication highlighting the psychological aspects of Diabetes being published in an Indian Journal. This to me is refreshing as at least now we have begun to recognize the importance of psychosociology in noncommunicable diseases. As pointed out by the authors, the intervention delivered in the study was based on the curriculum from the American Association of Diabetes Educators’ Fundamentals of Diabetes Care course for HCTs. A meta-analysis of 39 studies provides ample evidence on the importance of psychosociology of Diabetes.[2] It pointed out that 11% of patients with diabetes met the criteria for comorbid, major depressive disorder and 31% experienced significant depressive symptoms; in addition, the prevalence of depression in patients with diabetes was significantly higher in women than men (28 and 18%, respectively; P < 0.0001). It further mentions that in the controlled studies, the odds of having depression were twice as great in patients with diabetes as in their nondiabetic counterparts (odds ratio, 2.0; 95% confidence interval, 1.8-2.2). Now given the number of diabetics we have in India, the magnitude of dealing with comorbid, particularly psychosocial conditions seems a daunting task. And it is herein that the role of various healthcare professionals in dealing with this issue needs to be underlined. But given the fact that we are still to evolve, a consensus on this makes it a difficult job for healthcare providers.

In this regard, I went through a literature search on similar guidelines for Indian patients, but was surprised to find none. The closest we came to dealing with this aspect in noncommunicable diseases is providing statements, like creating awareness etc., without clearly outlining how exactly this will be done. In this regard, I also went through Indian Public Health Standards-12 published by the Ministry of Health and Family welfare, Govt. of India and therein also, I was unable to find anything in terms of guidelines for dealing with psychosociology of noncommunicable diseases.[3] I hope that this paper will initiate a chain of papers on this topic and probably pave a way in this direction.